Closing the Loop: Positive Feedback During Nursing Handoff

Despite introducing a nurse fellowship program in our unit, transitioning our newly graduated nurses continues to challenge us. Four new graduate nurses in the Neurosurgical ICU resigned within a year after completing the critical care fellowship. The Collaborative Care Council (CCC) is a form of shared governance and an open forum for nurses to voice their concerns. During the monthly CCC meeting, various concerns regarding the use of constructive criticism during shift handoff were reported by new graduate nurses.

Skilled communication and true collaboration are two crucial components of AACN’s six healthy work environment (HWE) standards. To help address the graduate nurses’ concern, I utilized consensus decision-making and created a positive feedback loop to improve bedside handoff and communication. The project aims to improve communication, socialization and work satisfaction among novice nurses to promote organizational commitment and decrease turnover.

I developed the feedback loop “Let’s CHAT,” which encourages compliments, addresses hurdles, acknowledges hard work and promotes teaching during nurse-to-nurse handoffs. I coordinated and conducted multiple meetings with all the stakeholders to discuss evidence and peer-reviewed articles, and I introduced the feedback loop. I was permitted to modify the standardized handoff tool and customize it to the needs of the unit. The feedback loop “Let’s CHAT” is a catchy acronym for the following:

• CCommunicate and include a Compliment

• HHurdles that need Help overcoming

• AAcknowledge and Appreciate hard work

• TTeach and Thank

The feedback loop was strategically placed at the end of the handoff tool to prompt nurses to provide feedback at the end of the shift report. The incoming nurse initiates the feedback loop at the end of shift handoff and is encouraged to customize “Let’s CHAT” to promote autonomy and ease. I provided one-on-one education to the nursing staff to discuss the purpose, importance and proper use of the positive feedback loop. The goal of utilizing the feedback tool is reiterated during daily huddles to engage and encourage the nurses. A few nurses who were early adopters were selected as “secret spotters” to ensure the feedback loop was used during handoff.

Orienting a new graduate nurse through the fellowship program costs roughly $85,000. If fringe benefits are added to the equation, the amount increases to approximately $113,000. The preceptor pay is $1,500 while orienting a new fellow, in addition to their salary. Retaining one new graduate nurse in the fellowship can save the hospital approximately $125,000. Eleven out of 13 novice nurses (one-18 months post-fellowship) completed the pre-survey and post-survey (one -year post-implementation). The results showed:

• The participants experienced an increase in confidence as well as satisfaction during handoff.
• The rate of bedside handoff reports increased.
• There was an increased sense of camaraderie and socialization among the nursing staff.
• We have retained every novice nurse and a new fellow since implementation of the project.

Implementing AACN’s HWE standards in your unit can improve patient outcomes, increase nursing satisfaction and reduce turnover.

What are some of the measures you are undertaking to incorporate HWE standards in your unit?